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Healthy Skepticism Library item: 3865

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: news

Burns G.
New doctors are allergic to freebies
Chicago Tribune 2006 Mar 12
http://www.chicagotribune.com/business/chi-0603120479mar12,1,4458437.story?track=rss


Notes:

Ralph Faggotter’s Comments:

“He’s probably doing a disservice to his patients,” said Scott Lassman, assistant general counsel at PhRMA, the Pharmaceutical Research and Manufacturers of America. “What he’s cutting himself off from is some very valuable, useful information that the sales representatives can provide. The companies are really in the best position to provide information about their products.”

The truth is the opposite of what Mr Scott Lassman claims.

It is by listening to drug reps, that the doctor is doing his/her patients a disservice.

For some doctors, getting honest, accurate and unbiased information has become a priority.
The pharmaceutical drugs reps promoting the drugs are the very last place you would look for such information.


Full text:

New doctors are allergic to freebies
They `just say no’ to drug companies

By Greg Burns
Tribune senior correspondent
Published March 12, 2006

Dr. Michael Mendoza has a ready answer when pharmaceutical sales representatives come calling: No.

He doesn’t take the personal gifts they offer as part of the estimated $13,000 per doctor spent in marketing prescription drugs each year.

Same goes for the free lunches and office supplies, although his clinic in Chicago’s needy South Shore neighborhood could probably use them. He won’t go on junkets, pocket consulting fees or even accept brand-name drug samples the clinic could distribute for free.

Mendoza believes taking such handouts would compromise his ability to do what’s best for his patients, and a growing body of research supports him.

Yet his “just say no” philosophy remains the exception in an industry where marketing expenditures continue to soar. Mendoza is part of a budding movement aimed at convincing youthful doctors to reject practices that have become routine among their more experienced brethren.

A conference in Chicago later this month will bring together the nation’s largest group of medical students with a new physicians organization composed of skeptics like the 31-year-old Mendoza. The aim, they say, is putting a stop to conflicts of interest that erode trust in their profession and ultimately make health care more costly and less effective.

“I feel like a pioneer,” Mendoza said as he sat in a windowless conference room at his clinic across from the Viva Liquor Store in a hardscrabble stretch of the South Side. “It may not be popular. I don’t know how successful I will be. But I think it’s right for the patient.”

Mendoza’s youth movement drew support earlier this year from an article in the prestigious Journal of the American Medical Association. The influential authors pushed for medical schools and affiliated hospitals to ban many common marketing tactics, before they become ingrained in students through their training.

Not surprisingly, the pharmaceutical industry begs to differ. Doctors like Mendoza who bar the door to sales reps may be undermining their own ability to practice good medicine, an industry spokesman said.

“He’s probably doing a disservice to his patients,” said Scott Lassman, assistant general counsel at PhRMA, the Pharmaceutical Research and Manufacturers of America. “What he’s cutting himself off from is some very valuable, useful information that the sales representatives can provide. The companies are really in the best position to provide information about their products.”

Refusing free samples, in particular, denies a “very tangible benefit” to the needy population Mendoza professes to serve, Lassman said.

Far from it, Mendoza countered. The industry won’t admit that its information is biased, its samples hook patients on designer drugs they cannot afford and its gifts translate into runaway costs when doctors reciprocate with their prescription pads, he said. “I kind of think they’re in denial.”

Like many veteran physicians, Mendoza’s boss at Access Community Health Network sees two sides to the issue.

Dr. Padmanabhan Mukundan agrees with Mendoza that doctors should turn down “the lunches and dinners and pens.” And he has vowed that Access, where he serves as medical director, will continue refusing samples unless a consistent supply of appropriate drugs can be assured.

But he also sees value in the knowledge that sales reps convey, especially through sponsoring lectures and the like. To that extent, he said, “They serve an important role.”

Still, the 59-year-old Mukundan said he is stirred by Mendoza’s passion, which goes beyond that of most young doctors who have passed through the community clinics he oversees.

“Mike is a little bit different,” he said. “He is an activist about it. He wants to make a difference, not just give an opinion.”

Mendoza didn’t set out to become an activist doctor in one of the city’s hard-pressed neighborhoods. Growing up in suburban Downers Grove, he found his niche on the high school math team and heading the National Honor Society.

He settled on environmental studies as a sophomore at the University of Chicago after flipping through the course catalog in search of a major that would get him out of the biology lab.

His casual choice led him to a graduate degree in public health at the University of Illinois, where he focused on the high-risk behavior of adolescents on Chicago’s South and West Sides.

He then earned a medical degree at the University of Chicago, and spent a three-year residency in family and community medicine at the rough-and-tumble San Francisco General Hospital, which he likens to Chicago’s Cook County Hospital.

He served a year as its chief resident before returning home last year with his wife, Dr. Lisa Vargish, who shares his interests in the healing arts as well as racing sailboats.

All through his medical education, pharmaceutical reps were right alongside him, passing out free food and post-it notes, paying for textbooks and sponsoring lectures preceded by sales pitches. “Every step of the way,” he recalled.

Reps outside door

Some departments and private clinics held once-a-week presentations complete with lunch, and students like him were expected to attend.

“I didn’t know the difference,” he said. “Someone seems authoritative. They present a study from a big journal. It sets up a pattern.”

In his final years of schooling, he remembers drug reps sitting just outside the door as the doctors reviewed active cases, waiting for the right moment to pitch their products. He enjoyed some good dinners at Roy’s, the Chicago Firehouse and other swanky spots, but came to resent the reps who passed off what he considered bad advice as scientific gospel.

“I remember them specifically because they were wrong,” he said. “These people were trying to get in bed with us as future physicians. The drug company was not giving you the whole picture.”

He recalls, for instance, a rep assuring him the powerful antibiotic Zithromax would be much better for acute bacterial sinusitis than cheap, generic amoxicillin. “It works,” Mendoza said. “But you can also kill a fly with a gun.”

Like two-thirds of his peers, Mendoza joined the American Medical Student Association. He started urging fellow students to rely on independent research, and at least some have taken the message to heart.

As the 56-year-old organization has embraced a more ambitious grass-roots activism, members such as Krishna Rao, a fourth-year student at Chicago’s Rush University Medical Center, have declared themselves “Pharm-Free.”

Rao has found plenty of unbiased sources, particularly through the Internet, to replace the information more commonly obtained from sales reps, he said. “I’m not missing anything. Other resources are out there.”

PhRMA spokesman Lassman disagrees. Industry reps have special expertise to answer all manner of technical questions, and their pitches conform to regulations and voluntary guidelines that eliminate bias, he said. Besides, doctors control every step of the interaction.

No question, many doctors believe their smarts and education make it impossible for gifts and samples to unduly influence them, although recent research suggests the opposite. Some doctors also view the freebies as a well-deserved perk, offsetting unfavorable trends in reimbursement rates, liability insurance and medical school debt loads.

“We come into a sense of entitlement very early on in our training,” said Leana Wen, a fourth-year medical student who heads AMSA, which meets in Chicago at the end of the month in conjunction with the National Physicians Alliance that Mendoza is helping to launch. “There’s this culture of largess.”

The groups expect 1,200 at the conference, which will feature a debate between a PhRMA executive and the founder of a health-care advocacy group called No Free Lunch.

So have young activists like Wen, Rao and Mendoza made a difference?

To a degree the numbers speak for themselves. The marketplace has continued to embrace many of the practices they want stamped out.

$7.3 billion spent

In 2004 the pharmaceutical industry allocated $7.3 billion in direct spending on health professionals, up 70 percent from five years earlier, according to the IMS Health research firm. The retail value of samples given away in the same period more than doubled to almost $16 billion.

Even amid questions about whether overexpansion has rendered the sales force less effective, few expect the dollars to drop anytime soon.

“That’s one measure of how unsuccessful we’ve been,” said Mendoza. “In the end, I can’t tell another physician how to practice medicine. Hopefully, we lead by example.”

Mendoza’s boss thinks he’ll do just that. Asked if Mendoza will change his views as he gains experience. Mukundan paused a moment, then replied, “Knowing him to the extent I do, I don’t think he will change that much.”

—————

Gburns@tribune.com

Copyright © 2006, Chicago Tribune

 

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963